Chronic cortisol excess: exogenous (steroids) or endogenous (pituitary, adrenal, ectopic ACTH).
History taking
- • Weight gain (truncal), easy bruising, proximal weakness, menstrual change
- • Steroid use including topical/inhaled
Examination
- • Moon face, buffalo hump, purple striae, hypertension
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Confirm: 1 mg overnight DST, 24-h urinary free cortisol, late-night salivary cortisol (need 2 positive tests)
- • Localise: ACTH, pituitary MRI, adrenal CT
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Endocrinology
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
